| NPI | 1417900820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 17027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD0000023683) |
| 207P00000X Emergency Medicine (Licence: TN 23683) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-05-08 |